There is a wealth of research on the extent to which bone loss may impair strength and increase the risk of fracture. The rate of mortality after hip fracture in elderly patients with osteoporosis is reported to be as high as 30%. It is suggested that augmentation of the femur is an effective countermeasure to reduce the risk of fracture in highly osteoporotic hips. This technique would be especially valuable for those patients at high risk of falls and the highest risk of mortality and morbidity if they were to sustain a fall. The few clinical case studies that have been performed on augmentation of the femur, suggest that a successful outcome requires detailed planning, biomechanical analysis, and precise control of the augmentation procedure to avoid generation of areas of high stress due to augmentation. Our long term goal is to develop a technology that enables the surgeon to precisely determine the extent of osteoporosis and fracture risk level, obtain an optimized surgical plan based on computerized mechanical analysis, perform a rapid and minimally invasive hip augmentation with intraoperative biomechanical feedback, and finally verify the outcome in one patient visit. In this project, we will develop a surgical testbed for proximal femur augmentation and demonstrate its feasibility. Towards this goal, we propose three aims: 1. Develop a geometrical and biomechanical planning module for patient-specific optimization of the bone augmentation procedures using preoperative CT scans. 2. Develop an integrated surgical execution system that will involve co-registration of the preoperative model and surgical tools with a fluoroscope and an optical navigation system specifically developed for this project. 3. Validate functional performance and overall system accuracy. The technology developed in this project may lead to a highly needed alternative treatment that may be pivotal for patients at the risk of bone fracture due to osteoporosis. The technology developed in this project, will provide a highly needed alternative treatment for patients highly susceptible to bone fracture due to osteoporosis.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21EB007747-03
Application #
7665545
Study Section
Special Emphasis Panel (ZEB1-OSR-B (M1))
Program Officer
Krosnick, Steven
Project Start
2007-08-15
Project End
2012-12-31
Budget Start
2009-08-01
Budget End
2012-12-31
Support Year
3
Fiscal Year
2009
Total Cost
$369,931
Indirect Cost
Name
Johns Hopkins University
Department
Type
Organized Research Units
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Basafa, Ehsan; Murphy, Ryan J; Otake, Yoshito et al. (2015) Subject-specific planning of femoroplasty: an experimental verification study. J Biomech 48:59-64
Xin Kang; Armand, Mehran; Otake, Yoshito et al. (2014) Robustness and accuracy of feature-based single image 2-D-3-D registration without correspondences for image-guided intervention. IEEE Trans Biomed Eng 61:149-61
Basafa, Ehsan; Armand, Mehran (2014) Subject-specific planning of femoroplasty: a combined evolutionary optimization and particle diffusion model approach. J Biomech 47:2237-43
Basafa, Ehsan; Armiger, Robert S; Kutzer, Michael D et al. (2013) Patient-specific finite element modeling for femoral bone augmentation. Med Eng Phys 35:860-5
Lucas, Blake C; Otake, Yoshito; Armand, Mehran et al. (2012) An active contour method for bone cement reconstruction from C-arm x-ray images. IEEE Trans Med Imaging 31:860-9
Sadowsky, Ofri; Lee, Junghoon; Sutter, E Grant et al. (2011) Hybrid cone-beam tomographic reconstruction: incorporation of prior anatomical models to compensate for missing data. IEEE Trans Med Imaging 30:69-83
Sutter, Edward G; Mears, Simon C; Belkoff, Stephen M (2010) A biomechanical evaluation of femoroplasty under simulated fall conditions. J Orthop Trauma 24:95-9